Provider First Line Business Practice Location Address:
150 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-543-8080
Provider Business Practice Location Address Fax Number:
619-298-0177
Provider Enumeration Date:
07/13/2006